Efficacy and safety of chemoradiation therapy compared with chemotherapy for esophageal carcinoma: An updated meta-analysis of randomized controlled trials.

BACKGROUND

The role of the chemoradiation therapy (CRT) and chemotherapy (CT) in the treatment of esophageal carcinoma (EC) remains controversial. Therefore, we conducted this meta-analysis to compare the efficacy and safety of CRT with CT in the treatment of EC patients.

METHODS

PubMed, Embase, Web of Science, and The Cochrane library were systematically reviewed for randomized controlled trials (RCTs) that compared CRT with CT. Outcomes included overall survival (OS), progression-free survival (PFS), pathological complete response (pCR), R0 resection, recurrence rate, mortality rate, and adverse events. Pooled estimates were expressed with hazard ratio (HR) with 95% confidence intervals (95% CIs) and risk ratio (RR) with 95% CIs.

RESULTS

Eight RCTs involving 1274 patients were included in this meta-analysis. Compared with CT, CRT was not associated with significantly improved OS (HR = 0.91, 95% CI: 0.82, 1.01; P = .072) and PFS (RR = 3.62, 95% CI: 1.10, 11.95; P = .035). The pCR rate and R0 resection rate were significant higher in the CRT group than that in the CT group (RR = 3.62, 95% CI: 1.10, 11.95, P = .035; RR = 1.18, 95% CI: 1.09, 1.27, P < .001; respectively). EC patients who received CRT had a higher mortality rate (RR = 2.50, 95% CI: 1.14, 5.48; P = .022) than those treated with CT, and the incidence of grade 3 or 4 adverse events was similar between the 2 groups (RR = 0.91, 95% CI: 0.62, 1.32; P = .612).

CONCLUSION

On the basis of the current evidence, our results suggested that CRT seemed to have benefit in the radical resection, but no effect in the survival benefits. Further large-scale, well-conducted RCTs are needed to verify our findings.